UMass Memorial, state settle fraud charges for $66K

UMass Memorial Medical Center will pay $66,000 to Massachusetts to settle allegations it improperly sent bills for uninsured patients to a homeless shelter so it could then submit the charges to a state program for payment, the Worcester Business Journal Online reports.

The whistleblower case was filed in federal court in Worcester in March 2012 by Nelson Castro, a former collections analyst who worked for the Worcester-based academic medical center, which is part of the UMass Memorial Health Care system. He filed the suit after reporting his findings of misconduct to his bosses, who allegedly dismissed the allegations as "insignificant," WBJ reported.

According to the Worcester Telegram, the federal government--originally included as a plaintiff in the lawsuit--investigated the case but declined to pursue it.

Court documents indicate Castro claimed UMass Memorial sent unpaid bills to the People in Peril homeless shelter in Worcester, in an alleged scheme that would allow the hospital to collect reimbursements through the state's Health Safety Net and Medicaid programs, which provide hospitals with reimbursements for uninsured patients.

WBJ reports the court documents state UMass Memorial provided emergency care to the patients but they never listed the shelter as their address. Although Castro claimed UMass Memorial billed more than $10 million in fraudulent payments as part of the ploy, Attorney General Martha Coakley's office said the figure was overblown, which is why the settlement is so much smaller.

Despite the settlement, the Worcester Telegram reports UMass Memorial denied all allegations. In a statement, spokeswoman Margaret Thrappas said the hospital has "fully cooperated with the Massachusetts attorney general's office in the matter, which is now fully resolved with a minimal payment."

As part of the $66,000 settlement, Castro will receive $13,200, according to the Telegram.

For more:
- read the WBJ article
- here's the Telegram story

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